Definition and Overview

Fecal peritonitis is a condition wherein the peritoneum becomes infected by fecal matter in the peritoneal cavity, a thin tissue that lines the inner wall of the abdominal cavity. Although it is made up of thin protective tissues, the peritoneal cavity is not immune to diseases and can develop various medical conditions including mesothelioma and peritonitis, or the inflammation of the peritoneum. In many cases, the inflammation develops due to an infection caused by bacteria but in others, it occurs spontaneously resulting in SBP (spontaneous bacterial peritonitis).

There are also instances wherein the condition is caused by foreign matter such as feces, blood, or the contents of a ruptured cyst leaks into the peritoneum. This inflammatory reaction is accompanied by various symptoms, including severe abdominal pain.

The presence of fecal matter in the peritoneal cavity is a serious medical condition, as it can lead to abdominal sepsis, a potentially life-threatening condition.

Causes of Condition

Peritonitis is an abdominal condition wherein the peritoneum or peritoneal cavity becomes inflamed. It can be traced back to many different causes, and come in various forms. One example is sclerosing encapsulating peritonitis, a rare form of the condition that causes acute obstruction in the small bowel.

Peritonitis does not only affect humans but also cats. In such cases, it is called feline infectious peritonitis, which is a fatal and incurable disease with a high feline mortality rate throughout the world.

In humans, one of the most common forms of the condition is called fecal peritonitis, which occurs when fecal matter leaks into the peritoneal cavity and causes an infection. This leakage is commonly traced back to colon perforation, which may occur due to abdominal trauma, surgical complication, ingestion of a sharp object, or the incorrect insertion of an endoscope or catheter during a medical procedure.

Peritonitis may also occur due to the leakage of blood, bile, urine, pancreatic juice, and other bodily fluids into the peritoneal cavity. Among the different kinds of peritonitis, fecal peritonitis is considered as one of the most serious. Once feces leak out of the colon and into the peritoneal cavity, an infection may develop within 24 to 48 hours. This condition is one of the most common causes of sepsis. As such, most patients are admitted to the ICU to receive proper critical care.

Fecal Peritonitis Symptoms

Patients with fecal peritonitis may suffer from the following symptoms:

  • Abdominal pain – The most telltale sign of fecal peritonitis is acute abdominal pain that occurs suddenly, seemingly with no obvious cause. The pain worsens when the peritoneum moves. Thus, even simple actions such as coughing or flexing the hips may cause the pain to intensify. The pain can be localised (affects just one part of the abdomen) or generalised, wherein the whole abdomen is affected.

  • Fever

  • Sinus tachycardia

  • Diffused abdominal rigidity or abdominal guarding

  • Intestinal paralysis, which causes nausea, bloating, and vomiting

When these peritoneal signs and symptoms occur without a known cause, patients are advised to undergo a screening test immediately.

Who to See and Types of Treatments Available

Patients who experience the above symptoms are advised to seek medical attention immediately. They can initially go to their family doctor or general practitioner, who will focus mainly on investigating the causes of the symptoms. The GP can perform basic diagnostic procedures to rule out other causes of the condition before making necessary referrals for admission to the ICU.

Fecal peritonitis is diagnosed with the use of abdominal x-rays, computed tomography (CT) scans, or an exploratory peritoneal laparoscopy. X-rays may detect the presence of pneumoperitoneum, a sure sign of gastrointestinal perforation. Some doctors also obtain a blood culture to rule out abdominal sepsis before recommending the best course of treatment.

Once the condition is diagnosed, the patient should receive peritonitis treatment immediately. The treatment will focus on:

  • Source control, or controlling or correcting the source or cause of fecal leakage

  • Eliminating toxins and bacteria from the peritoneal cavity

The majority of fecal peritonitis cases are linked to recurrent abdominal sepsis. In such cases, source control can be quite challenging. Source control should begin immediately after the condition is diagnosed. Without it, treatment is likely to fail increasing the risk of re-intervention and death.

Thankfully, recent studies showed that laparotomy and abdominal lavage and debridement could help improve outcomes for patients suffering from said condition.

Aside from laparotomy and abdominal lavage/debridement, treatment may also involve:

  • Antibiotic therapy – Broad-spectrum antibiotics are administered either intravenously or directly into the peritoneum.

  • Intravenous rehydration – Patients are monitored and kept hydrated to correct electrolyte imbalance.

  • Gram positive and gram negative organisms – Patients may also receive cephalosporins, cefoxitin, cefotetan, or beta-lactams.

All treatments are performed by intensivists or physicians who provide critical care for all ICU patients.

Many patients with fecal peritonitis, especially those who are suspected or diagnosed with perforation in the colon, may require surgery. The primary procedure used to treat fecal peritonitis is laparotomy, which allows surgeons to fully explore the peritoneum to remove all fecal matter and correct the problem that caused the infection or inflammation in the first place. Now, however, more and more doctors support the use of laparoscopic surgery for the treatment of abdominal infections such as fecal peritonitis. As techniques and technologies used to perform such minimally invasive procedures continue to improve, the use of laparoscopic surgery for the treatment of fecal peritonitis is expected to increase further.

Presently, the mortality rate of fecal peritonitis is at least 40 to 50 percent among elderly individuals, but the number drops to just 10 percent among healthy individuals who receive prompt and proper surgical treatment for the condition. On the other hand, if it is not treated properly, fecal peritonitis may have fatal consequences.

References:

  • Paul V, Tridente A, Kaur P, Mahmood M, Meliors R, Raithatha AH. 2015. “Critically ill patients with faecal peritonitis: a 5-year review in a tertiary centre.” Critical Care. 19(Suppl 1):P374. https://ccforum.biomedcentral.com/articles/10.1186/cc14454

  • Peralta R. MD FACS. “Surgical approach to peritonitis and abdominal sepsis.” Medscape. http://emedicine.medscape.com/article/1952823-overview

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